Amityville Internal Medicine, P.C.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

132857 Issued in NY

Legal business name

AMITYVILLE INTERNAL MEDICINE, P.C.

Practice address

49 Ireland PL
Amityville, NY 11701-2902

Phone

(631) 264-0924

Fax

(631) 264-3503

NPI assigned

Mar 17, 2008

Last updated

Apr 13, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelli Quenzer

Title

Billing Secretary

Phone

(631) 264-0924

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428883200000",
    "number": "1780855817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 IRELAND PL",
            "city": "AMITYVILLE",
            "state": "NY",
            "postal_code": "117012902",
            "telephone_number": "631-264-0924",
            "fax_number": "631-264-3503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 IRELAND PL",
            "city": "AMITYVILLE",
            "state": "NY",
            "postal_code": "117012902",
            "telephone_number": "631-264-0924",
            "fax_number": "631-264-3503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMITYVILLE INTERNAL MEDICINE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-17",
        "last_updated": "2015-04-13",
        "status": "A",
        "authorized_official_last_name": "QUENZER",
        "authorized_official_first_name": "KELLI",
        "authorized_official_title_or_position": "BILLING SECRETARY",
        "authorized_official_telephone_number": "631-264-0924"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "132857",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "WJ6411",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00447296",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Amityville, NY
• Providers in Amityville, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.